About this ebook

This ebook is about managing breathlessness. It is for anyone who is breathless due to cancer or its treatment.

The ebook explains the causes of breathlessness and the different ways to manage it. It has breathing and relaxation techniques. It also explains medicines to control breathlessness.

We hope it helps you deal with breathlessness and answers some of the questions you may have. Carers, family members and friends might find this information helpful too.

We cannot give advice about the best treatment for you. You should talk to your doctor, who knows your medical history.

How to use this ebook

This ebook is split into sections to help you find what you need. You do not have to read it from start to finish. You can use the contents list to help you.

It is fine to skip parts of the ebook. You can always come back to them when you feel ready.

At the end of the ebook, there are details of other organisations that can help.

We have a relaxation CD for people with breathlessness. It is called Relax and breathe.

Quotes

In this ebook, we have included quotes from people who have breathlessness, which you may find helpful. Some are from our Online Community (macmillan.org.uk/community). The others are from people who have chosen to share their story with us. This includes Clare, who is on the cover of this ebook. To share your experience, visit macmillan.org.uk/shareyourstory

For more information

If you have more questions or would like to talk to someone, call the Macmillan Support Line free on 0808 808 00 00,

7 days a week, 8am to 8pm, or visit macmillan.org.uk

If you would prefer to speak to us in another language, interpreters are available. Please tell us, in English, the language you want to use.

If you are deaf or hard of hearing, call us using NGT (Text Relay) on 18001 0808 808 00 00, or use the NGT Lite app.

We have some information in different languages and formats, including audio, eBooks, easy read, Braille, large print and translations. To order these, visit macmillan.org.uk/otherformats or call 0808 808 00 00.

The lungs and breathlessness

The lungs

When you breathe in, air passes from your nose or mouth through to the windpipe (trachea). The trachea divides into two tubes (airways) that go to each lung. These tubes are called the left and right bronchus.

Air passes through each bronchus into the lungs through smaller tubes called bronchioles. At the end of the bronchioles, there are tiny air sacs called alveoli. This is where oxygen from the air you breathe in (inhale) passes into the blood. Then oxygen is moved around the body in the blood.

A waste gas called carbon dioxide passes from the blood into the air sacs (alveoli). You get rid of carbon dioxide when you breathe out (exhale).

Just below the lungs is a dome-shaped sheet of muscle called the diaphragm. When you breathe, the diaphragm and the muscles between the ribs contract. This sucks air into the lungs. Then they relax. This pushes air out of the lungs. These are the main muscles used for breathing when you are relaxed.

During heavy exercise, the muscles in your shoulders and upper chest can also help with breathing. These muscles are not meant to work for long periods of time and get tired easily.

The lungs are covered by a lining (membrane) called the pleura. The pleura has an inner and outer layer. The inner layer covers the lungs. The outer layer lines the ribcage and the diaphragm. The pleura produces fluid that acts as a lubricant. This allows the lungs to move in and out smoothly.

Upper airways and the lungs

Causes of breathlessness

There are different causes of breathlessness (feeling short of breath). Your doctor can tell you what may be causing your breathlessness.

If your breathlessness gets worse quickly or you have pain when you breathe, contact your doctor straight away – you may need urgent treatment. If you cannot speak to your doctor and your breathlessness continues to get worse, go straight to your nearest A&E (emergency department).

Cancer affecting the lungs

This can be cancer that:

- started in the lungs (primary lung cancer)

- has spread to the lungs from another part of the body (secondary cancer).

Treatments such as radiotherapy or chemotherapy may help shrink the tumour and relieve breathlessness caused by the cancer.

We have information about the type of cancer you have and its treatments.

A build-up of fluid in the lining of the lungs or tummy

If cancer cells irritate the lining of the lungs or tummy (abdomen), this can cause a build-up of fluid.

A build-up of fluid in the lining of the lungs is called a pleural effusion. It means there is less room for the lungs to expand.

A build-up of fluid in the tummy is called ascites. It means the fluid takes up more space and pushes the diaphragm up. This makes it harder to breathe properly.

Pleural effusion and ascites are treated by taking the fluid away.

Low levels of red blood cells in the blood (anaemia)

This can be due to the cancer or cancer treatments, such as chemotherapy or radiotherapy. Red blood cells carry oxygen around the body. If the level of red blood cells in your blood is low, you may become more tired and breathless.

Your doctors may recommend that you have a blood transfusion.

Chest infections

A chest infection can cause phlegm (mucus) in the airways. This can make you feel breathless. Drinking plenty of fluid will make the phlegm easier to cough up. Contact your doctor straight away if you have:

- a high temperature (above 37.5°C or 99.54°F)

- a chesty cough

- pain when you breathe.

They can give you antibiotics, if needed.

Weakened muscles

In advanced cancer, the muscles that help you breathe can become weaker. This may be due to tiredness (fatigue) and not being able to do much physical activity. Not feeling hungry is also common in advanced cancer. This often means people do not eat enough and lose weight. These can all make breathing more difficult, as the muscles have to work harder.

You may find our booklets Coping with advanced cancer, Coping with fatigue (tiredness) and Physical activity and cancer helpful.

Pain

Pain can make it hard to breathe and move comfortably. Tell your doctor if you have any pain. They can make sure it is well controlled. There are different types of painkiller that can help. You may find our booklet Managing cancer pain helpful.

A blood clot in the lung (pulmonary embolism)

This can cause sudden breathlessness and pain when you breathe. If you have these symptoms, contact your doctor straight away. You may need urgent treatment.

Other conditions

Other conditions can cause breathlessness, such as:

- heart failure

- asthma

- chronic obstructive pulmonary disease (COPD)

- fluid in the lungs.

If you have any of these conditions, talk to your doctor about the treatment you need.

Smoking tobacco

Smoking makes breathlessness worse. The smoke irritates and inflames the airways. This means less oxygen is absorbed into the blood. There is help available if you want to stop smoking. Ask your nurse or doctor for advice or find out if there is a free NHS Stop Smoking Service near you.

We have more information in our booklet Giving up smoking and in our easy read booklet Stay healthy – Stop smoking.

Anxiety and panic

Feelings of anxiety and panic are common when you have a serious illness. They are natural reactions, but they can cause some people to have fast and shallow breathing. This can make you feel breathless, which can make you more anxious. Breathing and relaxation techniques can help break this cycle.

Cancer treatments

Surgery for lung cancer may involve removing part, or all, of a lung. Many people can breathe well after they recover from surgery, but some people may have long-term breathing problems after surgery.

Radiotherapy to the chest can cause inflammation of the lung (pneumonitis). This can lead to breathlessness. This is usually a short-term problem. But for some people it can last longer, and sometimes the problems do not go away. People who have intensive radiotherapy to the chest can sometimes develop hardening and thickening (scarring) of the lung. This can cause long-term breathlessness.

Some chemotherapy drugs can sometimes cause breathing problems. These drugs include bleomycin, cyclophosphamide, gemcitabine and methotrexate.

Some types of targeted and immunotherapy drugs can also cause inflammation of the lungs.

We have more information about chemotherapy, targeted and immunotherapy drugs on our website.

Breathlessness scale

Using a Borg scale

The Borg scale is sometimes used to measure breathlessness.

When you become breathless, using the scale may help give your family, friends and healthcare team a clear idea of how bad the breathlessness is. This can help them understand how much support you need.

The Borg scale can be used to give your breathlessness a number:

- 0.5 is no breathlessness at all.

- 10 is very, very severe breathlessness.

The Borg scale can also help you be aware of your breathing and how it changes, especially when you are being active.

If you feel too breathless to talk, you can point to a number on the scale to tell others how you are feeling.

Borg scale

0.5

No breathlessness at all

0

Very, very slight breathlessness (just noticeable)

1

Very slight breathlessness

2

Slight (light) breathlessness

3

Moderate breathlessness

4

Somewhat severe breathlessness

5

Severe (heavy) breathlessness

6

7

Very severe breathlessness

8

9

10

Very, very severe breathlessness

Coping with breathlessness

Coping with anxiety

Being breathless can make you feel anxious. Some people feel like they are having a panic attack.

Common symptoms of anxiety and panic are:

heart palpitations (heart beats that suddenly become noticeable)

- feeling sick

- sweating

- a dry mouth

- dizziness.

Anxiety may make you breathe too fast and take shallow breaths from the top of your lungs rather than your lower chest. This can make you feel more breathless, which can make you feel even more anxious.

A way to break this cycle of anxiety is to gradually slow your breathing rate. You can do this by doing controlled breathing exercises or relaxation techniques. You can also try using a handheld fan to blow air onto your face, and breathing out against the fan. This can also help calm your breathing.

Some people may need to take medication to help them manage their anxiety.

If you notice there are times when you breathe too fast (hyperventilate), try to recognise what triggered it. Talking about the cause with family or friends may help, because they will be aware of it next time. We have information about anxiety in our booklet How are you feeling? The emotional effects of cancer.

Relaxation

Breathlessness can make you feel anxious and panicky. These feelings can cause fast, shallow breathing, which can make you more breathless.

Learning and practising relaxation techniques can help you control anxiety and breathe more easily. We have described one technique you might like to try over the next few pages.

It can take practice to become good at it. So try it for 5 to 10 minutes once a day to start with. Then you can try to do it for longer. Set aside time during the day to practice. It might help to ask someone to read these instructions to you.

Relaxed breathing technique

Try to find a quiet and peaceful place to do this exercise. If you notice any sounds around you, try not to let them distract you.

Make yourself comfortable. You can do this sitting or lying down. Make sure your shoulders, back and neck are well supported. You may want to try using a high-backed chair. Have your arms by your sides or rest your hands on your lap.

1. Close your eyes.

2. Start by breathing out and then in, only as much as you need. Then breathe out slowly with a slight sigh,like a balloon slowly deflating.
Do this again, as slowly as you can. As you breathe out, feel any tension in your body start to drain away. Then let your breathing go at an even, steady pace.

When you feel comfortable doing this, you can move on to the next stage.

3. Start to think about each part of your body, one at a time.

4. Start with your toes. Wiggle them, then let them relax. Let them feel heavy, and free of any tension.

5. Now think about your legs and let your thighs relax and roll outwards.

6. Next, let your tummy muscles become soft and relaxed.

7. Make a fist with your hands, then let go. Let your fingers become limp and still. Let this relaxed feeling spread up your arms to your shoulders.

8. Let your shoulders relax and drop easily.

9. Let your neck muscles relax. Your head is resting and supported. Enjoy this relaxed feeling.

10. Let your face and expression relax. Make sure your teeth are not clenched and let your jaw rest in a relaxed position.

11. Now, as your body feels relaxed, become aware of the all-over feeling of letting go. Be aware of the feeling of quiet, calm and resting. Enjoy this relaxed feeling. If you find your mind becoming busy again, think about where your muscles have tensed and then relax them.

12. Slowly bring your attention back to the room. Have a gentle stretch and open your eyes. Remember to get up slowly when you have finished. If you managed to fully relax, your blood pressure may have dropped. So you may feel dizzy if you get up suddenly. Bending and stretching your arms and legs a few times before standing up should help.

When you feel comfortable doing the breathing exercise, it can help to listen to some relaxing music while you do it. You can listen on the internet or using an app. Imagine nice and peaceful surroundings while you do the exercise.

Other ways to relax

You may want to try other ways to relax. Relaxation CDs may be available from your local library or cancer centre. Or you can download an app or listen to podcasts.

Some hospitals, cancer centres and hospices offer breathing control and relaxation sessions. Ask your cancer doctor, specialist nurse or physiotherapist which sessions are suitable for you.

Breathing techniques

Breathlessness can be hard to live with, but there are ways you can reduce how much it affects your life. Learning some breathing techniques can help.

It helps to practise these breathing techniques for the first time when you are not too breathless, if possible. Then you will find them easier to do when you are feeling breathless. Knowing there are things you can do when you feel breathless can help you feel more in control. It might help for someone to read the instructions to you the first time.

Try to remember to do these breathing techniques as often as possible. It can take some time to get used to them. Try not to force the exercises or expect instant results. Aim for a slow change from breathlessness to controlled breathing.

To start, it might help to ask your specialist nurse or GP if you can see a physiotherapist or occupational therapist. They can help you learn these techniques.

Get into a comfortable position

When you feel breathless, get into a comfortable position that supports your upper chest muscles. This allows your diaphragm and tummy to expand fully.

Over the next few pages there are some comfortable sitting and standing positions that can help with breathlessness. There are photos of these positions on page 16.

Position 1

- Sit in a chair in an upright position, with your back supported.

- Keep your legs uncrossed and your feet on the floor.

- Let your shoulders drop and feel heavy, with your arms resting softly in your lap.

- Keep your head up.

Position 2

- Sit in a chair and lean forward with your upper body.

- Have your legs uncrossed, your feet on the floor and your shoulders relaxed.

- Slowly lean forward so your elbows and lower arms rest on your thighs, supporting your upper body.

- Keep your knees shoulder-width apart and let your chest relax when you lean forward.

‘My husband reminds me to breathe deeply, rather than as shallow as I do at times (especially when I don’t feel well). This really helps. I just need to be disciplined about breathing exercises. I also find paying attention to my breathing is very calming.’ Lynda

Position 3

- Stand and lean forward on to a secure surface.

- Let your arms and elbows rest on the surface, so you are supporting the weight of your upper body.

- Keep your shoulders and chest relaxed by keeping your arms shoulder-width apart.

Position 4

- Stand up and lean back against a wall.

- Let your arms drop to your sides and let your shoulders feel heavy and relaxed.

If you are in bed

- Try to sit up with your back supported by pillows. This allows you to expand and open your chest area.

- Let your head rest back gently on the pillow, so you can feel the tension leave your neck.

- Rest your arms by your sides. You can support them with pillows if this is more comfortable.

Controlled breathing

Breathlessness can make you breathe with your upper chest and shoulder muscles, rather than your diaphragm and lower chest. This causes fast and shallow breathing, which uses more energy and makes you tired.

An important part of managing breathlessness is learning a technique called controlled breathing. This uses your diaphragm and lower chest muscles to help you breathe more gently and effectively. It can also help you relax.

If you practice this when you are not too breathless, you will find it easier to do when you are breathless.

1. Sit comfortably, with your neck, shoulders and back well supported. Sitting on an upright chair is best.

2. Relax your shoulders.

3. Breathe in gently, through your nose if possible. Try to use your lower chest to breathe. When you inhale, your tummy area should expand, rather than your upper chest.

4. Breathe out slowly and watch your tummy sink back down.

5. Continue doing steps 1 to 4 until your breathing is more controlled.

To check you are breathing from the lower chest, put your hands on your tummy, just below your ribcage. As you breathe in, you should feel your hands rising. As you breathe out, your hands will sink back down. Your upper chest and shoulders should not move. Try to feel your lungs expand as more air can get in. It may also help to sit sideways next to a mirror, so you can see your lower chest moving in and out.

Breathe gently

When you are in a comfortable position, try breathing in through your nose and out gently through your mouth. Some people find it helpful to breathe out through pursed lips, like they are blowing out a candle. If you find it hard to breathe in through your nose, breathe through your mouth instead.

Relax your shoulders and upper chest muscles

When you breathe out, feel your shoulders and upper chest relax. As you breathe in, keep your shoulders relaxed. If this is hard to do, ask someone to press down gently on your shoulders to help relieve some of the tension.

Breathe in slowly and breathe out gently, feeling your upper chest muscles relax more and more with each breath out.

‘I was very breathless for a while, but slowly it improved. Now I get breathless, but not as badly. I try to walk each day, and when I struggle to do my housework, I rest.’ Michael

Using a handheld fan

Studies have shown that using a handheld fan is a simple but helpful way of helping breathlessness. It can help you recover more quickly when you are feeling breathless. You usually notice a difference within a couple of minutes. Carry a handheld fan with you to use whenever you need it. These fans are small, light and easily fit into a handbag or pocket. A floor-standing fan or desktop fan can also be helpful.

Tips for using a fan:

- Get into a comfortable position. If you are not sure about positioning, ask a doctor, nurse or physiotherapist at the hospital.

- Hold the fan yourself if possible. Keep it about 15cm (6in) away from your face.

- Let the cool air blow towards the middle of your face, always including your nose and mouth.

Sitting in front of an open window with the cool air blowing over your face can also be helpful. Some people find putting a cool flannel on their face also helps.

You can watch a video on how to use a handheld fan the right way from the Breathlessness Intervention Service at Cambridge University Hospitals.

Medicines and other help for breathlessness

Medicines

There are different medicines that can help with breathlessness. You can talk to your GP or a cancer doctor or specialist nurse at the hospital.

Painkillers

Some types of painkiller can help relieve breathlessness. For example, morphine can be taken as a tablet, in liquid form, or by injection under the skin.

Sedative drugs

Breathlessness makes some people feel anxious. Sedatives can help relieve anxiety. It is always better to try to learn some relaxation exercises to help with breathlessness, before trying sedatives.

Steroids

Steroids can help reduce inflammation in the airways of the lungs. This helps reduce breathlessness.

Bronchodilator drugs

Bronchodilator drugs widen the air passages and increase airflow. You usually have them through an inhaler. If you find it hard to use an inhaler, your GP or practice nurse may give you a spacer device. This helps make sure the drug from the inhaler reaches the lungs.

Bronchodilator drugs can sometimes be given as tablets.

The drugs can also be given through a small machine that turns the liquid drug into a fine mist. This machine is called a nebuliser. It lets you breathe the drug deep into your lungs. You breathe through a mask or a mouthpiece to inhale the drug.

Sterile salt water (saline)

This can be given through a nebuliser to loosen sticky phlegm (mucus).

Diuretics

Diuretics are medicines to help you pass more urine (pee). They can help if your breathlessness is caused by having too much fluid in or around the lungs. These drugs help you get rid of excess fluid. You may have them as tablets, or sometimes as a drip (infusion).

Oxygen treatment

Oxygen is used to help with low oxygen levels, not to treat breathlessness. So oxygen treatment is only suitable for people who are breathless because of low oxygen levels in the blood.

If your oxygen levels are not low, other ways to manage breathlessness may work better. Your doctor or nurse can tell you more about this.

Using a fan or sitting by an open window with cool air blowing on to your face may give the same benefit. Your doctor may give you oxygen treatment if you have tried other ways but still feel breathless.

If you only need oxygen for short periods, your doctor may recommend an oxygen cylinder. This is a storage cylinder filled with oxygen for you to breathe.

If you need oxygen for longer periods of time, they may suggest an oxygen concentrator. This is a bigger machine that takes and filters oxygen from the air around you.

You breathe in the oxygen using a face mask or through small tubes that sit under the nostrils (nasal cannula). Try using a water-based lubricant like K-Y Jelly® to stop your lips or nostrils getting dry. You should not use petroleum jelly (Vaseline®) when using oxygen, because it is dangerous.

If you want to go out but need oxygen, you can get a portable cylinder. If you use a wheelchair, you can have a bracket fitted to carry the cylinder. Ask the wheelchair service about this.

If you want to travel with oxygen, there are a few things to consider. You can find out more about this from the British Lung Foundation or your local NHS service.

Smoking

Smoking is not allowed in a house where there is home oxygen. If you or people you live with smoke, you cannot use oxygen at home. This is because of a serious risk of explosion and fire.

If you smoke, you need to tell the doctor prescribing the oxygen.

Complementary therapies

Finding a complementary therapy that helps you relax may help you manage your breathlessness. Therapies such as acupuncture, aromatherapy and meditation may be helpful. Always tell your doctor if you are thinking of starting any new therapies. We have more information in our booklet Cancer and complementary therapies.

‘There are limitations because of cancer and the side effects of my medication. But I’vetaught myself not to be scared of adapting exercises.’ Clare

Practical tips for daily activities

It is good to keep active, but when you are breathless, even normal activities can feel overwhelming. You can ask to see a physiotherapist or an occupational therapist (OT) for some expert help with this. Some of the following tips may also help.

Prioritise

Save your energy for the things that most need doing, or are most important to you. Before doing a task, think about whether you need to do it now. If it is not necessary, think about doing it at another time.

If it is a more active task, ask family or friends to help if you can. Do everything the easiest way possible. Give yourself extra time to do things, so you are not rushed or stressed. This should make you less likely to get breathless.

Plan ahead

It may make some tasks easier if you plan ahead. For example, you could do your shopping online or ask someone to do it for you, if you can. Most supermarkets offer online shopping and home delivery.

You might also find tasks are easier at a certain time of day. It can help to write a diary to help you see any patterns in when you are more or less breathless. You can use this to plan ahead, so you can do the things you want to at times when you are likely to find them easier.

Pace yourself

Keep a balance between being active and resting. You may also want to take breaks during activities.

Make a plan for what to do when you are breathless

You may find it helpful to write down a plan for when you feel breathless. For example, this could be a resting position that you know helps, having the fan turned on or the window opened. This means any carers you have are aware of things that help and can support you when you are breathless. It can help to talk through possible ideas with a physiotherapist or OT too.

‘Bending is a problem. I have to be careful when picking something up from the ground. I must bend my knees like I’m sitting, and then pick it up.’ Terry

Around the house

You may be eligible for grants to make changes to your house or for extra pieces of equipment that can help. An OT or physiotherapist can also give you practical help and advice. Here are some things you may want to consider:

- Think about ways to arrange your home to make tasks easier. For example, it might help to put a chair in a hallway or landing, so you can rest when walking between rooms.

- Sit down to do tasks like washing, dressing or preparing food.

- Arrange your kitchen so the things you use often are at waist height. This means you do not have to bend or stretch to reach cupboards.

- Try to avoid bending from the waist down, as this can restrict your breathing. Instead, try bending your knees, while keeping your back straight. This keeps your chest upright and your shoulders back. You may find it helps to hold on to a secure piece of furniture. Some people find it helpful to use a grabbing stick or reacher. This is sometimes also called a pick-up stick. An OT can give you advice on this.

‘I get breathless now, so rather than carrying watering cans around the garden, I’m going to try and get a long hose.’ Mary-Jane

- Try not to lift heavy items, as this can make you tired and short of breath. Laundry or shopping are easier to carry in a trolley. Give yourself as much rest as you need. Do not be afraid to ask for help from family and friends if you can. If you live alone and are struggling, talk to your GP about what help is available.

- Your physiotherapist may suggest a mobility aid, for example a walking frame (Zimmer frame). Some come with baskets, so you do not have to carry things.

- Try to push rather than pull a trolley. It may also help your breathing to rest on the handle in a forward-leaning position.

- Keep a phone close by. Using a cordless or mobile phone is easier. It might help to tell people who call you often that they need to give you plenty of time to answer.

- Think about getting an intercom system. For example, using a baby monitor lets you talk to someone in another room without having to shout or get up.

- Put lots of pillows behind you in bed to help support you in a more upright position. You can ask a physiotherapist which positions are best for you.

‘I sometimes sleep propped up on 4 or 5 pillows, which I find helps.’ Lynda

Getting dressed

- Sit down when you are getting dressed. Choose loose-fitting clothes, especially around the waist and chest. Bring your feet up to put on socks, tights and shoes, as bending at the waist can make you breathless. Slip-on shoes are easier to get on and off.

- When you get undressed, do not hold your breath as you take clothes off over your head. Take your arms out first, then quickly slip the clothes over your head. This means your face is only covered for a short time.

Having a bath or shower

- Bathrooms can get warm and quickly fill with steam. When you are having a bath or shower, open a window or leave the door slightly open.

- Keep the water warm but not too hot, as this can make you breathless.

- If you are having a bath, when you are undressed, sit at the side of the bath and slowly lift in one leg at a time. After your bath, you may find it easier to kneel up first and rest for a few moments before standing up.

- If you are having a shower, try to keep the spray away from your face. Some people find it helps to turn the water off while they soap themselves, and then turn it back on to rinse off. Sit safely on a seat or stool in the shower if there is enough space.

- A bathrobe or big towel wrapped around you will help you get dry without lots of rubbing and patting. Sit down while you dry yourself. Bring your feet up, so you do not have to bend to dry them. Remember to keep using gentle, controlled breathing from your tummy.

Going to the toilet

- If you find it hard to get to the toilet, it can help to use a urine bottle or commode (portable toilet seat and bowl). A district nurse can arrange this for you if you need it. Your hospital or GP can arrange for you to have a district nurse.

- Aids such as grab rails, a raised toilet seat and a bath board can make going to the toilet and bathing easier. An OT can visit you to see what might help make things easier for you around your home.

- If you are having problems pooing (constipation), get this treated quickly. Straining can make breathlessness worse.

Diet

You may find that breathlessness can cause problems with eating. If you are not managing to eat enough, you can add high-protein powders to your food, to add calories. You can also try adding some nutritious, high-calorie drinks. Your GP or dietician can prescribe these for you. They are also available from most chemists. You can ask to be referred to a dietitian at your hospital. If you are at home, your GP can arrange this for you.

Here are some other tips:

- Smaller meals on a smaller plate are easier to manage.

- Eat slowly and take smaller mouthfuls.

- Try to avoid chewy food.

- Try adding sauces or gravies to make food easier to eat.

- Drink sips of fluid often. This helps keep your mouth moist. It also helps stop phlegm getting sticky, which makes it easier to cough up. Drink at least 1½ litres (3 pints) of fluid a day, if you can.

- Ready meals can help on days when making food feels too difficult.

- Having a small alcoholic drink like sherry or brandy before a meal can help your appetite.

You might find our booklets Healthy eating and cancer and Eating problems and cancer helpful.

Dry mouth

Being breathless can make you breathe through your mouth more than your nose. This can make your mouth and tongue dry, which can leave a bad taste.

Here are some things that might help:

- If your tongue is ‘coated’, it may make your food taste unpleasant and put you off eating. If this happens, talk to your healthcare team for advice.

- Drink sips of fluid often. You may find fizzy drinks more refreshing. Keep water by your bed and take water with you when you go out.

- Try sucking ice cubes or ice lollies. You can make lollies by freezing fresh fruit juice in ice-cube trays or in special lolly containers with sticks.

- Keep your food moist with sauces and gravies.

- Avoid chocolate and pastry, as they can stick to the roof of your mouth.

- Tell your doctor about your dry mouth. They can prescribe mouthwashes, lozenges or saliva-like sprays or gels to help.

- Use lip balm for dry lips. But do not use lip balm if you are having radiotherapy to the head or neck area.

- If you need to moisten your lips while having oxygen, use a water-based lubricant (for example K-Y Jelly®) and not petroleum jelly (like Vaseline®).

We have more information about dealing with a dry mouth on our website.

Going out

If you are planning a day out somewhere you have not been before, it may help to get some information before you go. You might want to find out if there is a lift, parking, transport links, and how far you will have to walk.

The air in some places may be drier. For example, it might be drier if there is air conditioning or if it is a cold, dry day. This can cause a dry mouth or coughing. Taking a small bottle of water with you can help. You could also keep a handheld fan with you to help if you get breathless.

Some people find that when the air is cold outside, it can help to put a scarf across their mouth. This warms the air they breathe and adds moisture to it.

When you are walking outside, go slowly and use controlled breathing. Try to bring the rhythm of your breathing in line with your walking. You can do this by:

- breathing in on one step

- breathing out on the next two steps.

A walking stick, Zimmer frame or wheelchair can be useful when you are outside, particularly for longer trips. Your nurse, physiotherapist or OT can arrange these for you. You can also hire wheelchairs from the British Red Cross. Your local shopping centre or supermarket may also have wheelchairs you can borrow while you are there.

The Shopmobility, Motability and Blue Badge schemes may be able to help. Ask your nurse, OT or social worker for details.

Physical activity

Physical activity can improve your breathing. It helps you be as fit as possible and can make you feel better. Even people with severe breathing problems can benefit from small amounts of physical activity.

Physical activity will not necessarily make you more breathless, especially if you go slowly and use controlled breathing as much as possible. You may get breathless, but over time you will be able to do more before you get breathless.

By slowly doing more activity, you will get fitter and your muscles will get stronger. Over time, you will be more confident in your ability to control your breathing. You will also know when and how to do this. It can help to remember that breathlessness will usually go away in a few minutes.

If your breathlessness starts to get worse or gets worse quickly, make sure you see a doctor straight away. There may be a new cause for your breathlessness that needs treatment quickly.

Our booklet Physical activity and cancer treatment may be helpful. We also have a Move More pack with activity ideas.

Trying some physical activity

Start slowly by doing movements with your arms and legs while you are sitting down. Then set yourself goals that are right for you. For example, you might aim to walk from room to room, to the front door or to the garden. Or you might aim to go for a short walk. You can slowly build up what you do.

Remember to go slowly, use controlled breathing and match your breathing rhythm to your steps. You may find you are able to do a bit more each time. This will help you manage your everyday activities more comfortably. A physiotherapist can give you advice on the right type of physical activity for you. A pedometer or step counter can help you slowly increase the amount of walking you do each week.

Some hospitals and hospices have breathlessness services or rehabilitation programmes. They run exercise programmes specially for people with breathlessness. They also have different types of specialists who can give you advice to help you manage your breathlessness. Ask your specialist nurse if there is one in your area. If there is no breathlessness services in your area, you can ask to see a physiotherapist or OT for advice on how to manage breathlessness.

‘It’s about your mental health as much as physical health.’ Clare

Keep a diary

It can help to write down:

- when your breathlessness is difficult

- activities that make it worse

- what techniques you use to deal with it.

You may find there are certain times of the day when you need more energy, such as in the morning when you are getting dressed. Or you may find there are certain things that make your breathlessness worse, such as feeling stressed.

You can also use a diary to plan activities for times of the day when you feel better. And it can remind you to practise controlled breathing and relaxation techniques.

Sex and breathlessness

You may be worried about how being breathless may affect your sex life. If you have a partner, they may also be thinking about this. Sex takes energy and is tiring for the heart and lungs. It is important to recognise this and make some changes.

Here are some tips that may help:

- Be open with your partner about your worries and what may help. This can help you both enjoy a fulfilling sex life.

- Talking, hugging and touching are all important parts of intimacy that do not take too much energy.

- Try to have sex when you are feeling rested and your breathing is at its best.

- You might find it easier to have sex at a certain time of day, such as early evening rather than late at night.

- Some positions use less energy. You may need to try different positions to find what suits you best. The British Lung Foundation has illustrations of suggested sexual positions for people with breathlessness.

- Make sure you are as relaxed as possible and take things slowly.

- Sex after a big meal or alcohol might be more difficult, as your stomach will be full. Alcohol can also affect your sexual function.

- If you have oxygen at home, it may be helpful to use it before, during and after sexual activity.

- If you feel breathless while having sex, pause and take a few deep, slow breaths from your lower chest. Do this rather than completely stopping.

- Speak to your GP or specialist nurse if you want more advice. They can refer you to a sexual health counsellor.

We have more information about sex. You may find our booklets Cancer and your sex life - information for men, Cancer and your sex life - information for women, and Sex and relationships - support for young people affected by cancer helpful.

We also have an easy read booklet called Your sex life and cancer.

Your feelings

Your feelings may change over time. Some days you may feel well and relaxed. Other days you may feel scared, angry and sad. These are normal responses to breathlessness, cancer, treatment and any fears you have about the future. There is no right or wrong way to deal with these feelings, but accepting they are normal will help.

Sometimes you may feel you need to be alone. Other times you may want to be with people. Do what feels right for you at the time. You may have family and friends who find your changing emotions hard to understand. But try talking together about how you all feel. This can help you understand each other better and be able to cope with the problems more easily.

You may find it helpful to talk to other people who are going through similar experiences. There may be support groups in your area. Find out about local support groups by calling us on 0808 808 00 00 or visiting macmillan.org.uk/selfhelpandsupport You can also share your experiences of breathlessness with other people on our Online Community. Visit macmillan.org.uk/community

Feeling depressed

Many people feel sad because of their cancer and difficult symptoms such as breathlessness. This is natural, but if these feelings get worse, you may become depressed.

Depression can come on slowly and may be hard to recognise. If you are depressed, it may be harder for you to follow your treatment plan or your healthcare professionals’ advice.

Depression can usually be successfully treated in most people. The first step to feeling better is getting the right help. If you or your family or friends think you may be depressed, talk to your GP. They may recommend an antidepressant drug for you. Or they may refer you to a doctor or counsellor who specialises in helping people cope with emotional problems.

Feeling isolated

People with breathlessness can sometimes become isolated if it is hard for them to go out and meet family or friends. Talking in a big group of people can also be tiring.

You may feel you would rather avoid these types of social situation. If you do feel isolated, talking to family and friends can help. Tell them how you feel and how much you can do. Together, you can find a way to see each other that is less tiring for you.

Sending messages or using social media can also be a good way of keeping in touch with people, without using much energy.

Who can help?

Many people are available to help you and your family and friends manage the problems that breathlessness can cause.

Clinical nurse specialist

Specialist nurses can give you practical advice. They can refer you to other members of the healthcare team, to help you manage your breathlessness in the best way. They can also help you find support groups in your area.

Physiotherapist

Physiotherapists can help you learn breathing techniques. They can give you expert advice on gentle exercise and relaxation. They can also show you new ways of doing daily activities that may be causing you problems.

Occupational therapist (OT)

Occupational therapists can help you find ways of doing things at home safely and without getting too breathless. They can give you simple but useful tools, such as a grabbing stick. These can make daily tasks easier. OTs can also offer expert advice on relaxation and how to pace your daily activities.

Dietitian

Dietitians can give advice on food to make eating easier when you are breathless. They can also look at your diet.

They may recommend supplement drinks if you find it hard to eat enough food.

Community support

Different people can offer support in the community. District nurses (also called community nurses) work closely with GPs. They can make regular home visits when needed.

Specialist nurses called palliative care nurses (sometimes called Macmillan nurses) are experienced in managing symptoms. They can offer you practical and emotional support. They can also visit you at home and support you and your family.

Some palliative care nurses are linked to the local hospice. Your GP can usually arrange for you to be seen by a specialist nurse at home. If you have a local cancer centre, they may also have a hospice or palliative care team that can offer you specialist help with your breathing. Some hospitals have a specialist team for helping managing breathlessness.

Marie Curie nurses help care for people who are having treatment to control their symptoms and want to stay in their own homes. They give nursing care during the day and overnight. You can talk to your district nurse or GP about whether a Marie Curie nurse is suitable for you.

The hospital social worker can give you information about social services and other benefits you may be able to claim. For example, you may be entitled to meals on wheels, a home helper or money to help with the cost of getting to hospital. If you have children, the social worker may also be able to help arrange childcare and, if necessary, help with the cost of childminders.

About our information

We provide expert, up-to-date information about cancer. And all our information is free for everyone.

Order what you need

You may want to order some leaflets or booklets, or download more ebooks like this one. Visit be.macmillan.org.uk or call us on 0808 808 00 00.

We have booklets on different cancer types, treatments and side effects. We also have information about work, financial issues, diet, life after cancer and information for carers, family and friends.

All of our information is also available online at macmillan.org.uk/information-and-support There you’ll also find videos featuring real-life stories from people affected by cancer, and information from health and social care professionals.

Other formats

We also provide information in different languages and formats, including:

- audiobooks

- Braille

- British Sign Language

- Easy Read booklets

- large print

- translations.

Find out more at macmillan.org.uk/otherformats If you’d like us to produce information in a different format for you, email us at cancerinformationteam@macmillan.org.uk or call us on 0808 808 00 00.

Help us improve our information

We know that the people who use our information are the real experts. That’s why we always involve them in our work. If you’ve been affected by cancer, you can help us improve our information.

We give you the chance to comment on a variety of information including booklets, leaflets and fact sheets.

If you’d like to hear more about becoming a reviewer, email reviewing@macmillan.org.uk You can get involved from home whenever you like, and we don’t ask for any special skills – just an interest in our cancer information.

Other ways we can help you

At Macmillan, we know how a cancer diagnosis can affect everything, and we’re here to support you. No one should face cancer alone.

Talk to us

If you or someone you know is affected by cancer, talking about how you feel and sharing your concerns can really help.

Macmillan Support Line

Our free, confidential phone line is open Monday–Friday, 9am–8pm. Our cancer support specialists can:

- help with any medical questions you have about your cancer or treatment

- help you access benefits and give you financial advice

- be there to listen if you need someone to talk to

- tell you about services that can help you in your area.

Call us on 0808 808 00 00 or email us via our website, macmillan.org.uk/talktous

Information centres

Our information and support centres are based in hospitals, libraries and mobile centres. There, you can speak with someone face to face.

Visit one to get the information you need, or if you’d like a private chat, most centres have a room where you can speak with someone alone and in confidence.

Find your nearest centre at macmillan.org.uk/informationcentres or call us on 0808 808 00 00.

Talk to others

No one knows more about the impact cancer can have on your life than those who have been through it themselves. That’s why we help to bring people together in their communities and online.

Support groups

Whether you are someone living with cancer or a carer, we can help you find support in your local area, so you can speak face to face with people who understand. Find out about support groups in your area by calling us or by visiting macmillan.org.uk/selfhelpandsupport

Online community

Thousands of people use our online community to make friends, blog about their experiences and join groups to meet other people going through the same things. You can access it any time of day or night. Share your experiences, ask questions, or just read through people’s posts at community.macmillan.org.uk

The Macmillan healthcare team

Our nurses, doctors and other health and social care professionals give expert care and support to individuals and their families. Call us or ask your GP, consultant, district nurse or hospital ward sister if there are any Macmillan professionals near you.

Help with money worries

Having cancer can bring extra costs such as hospital parking, travel fares and higher heating bills. If you’ve been affected in this way, we can help.

Financial guidance

Our financial guidance team can give you advice on mortgages, pensions, insurance, borrowing and savings.

Help accessing benefits

Our benefits advisers can offer advice and information on benefits, tax credits, grants and loans. They can help you work out what financial help you could be entitled to. They can also help you complete your forms and apply for benefits.

Macmillan Grants

Macmillan offers one-off payments to people with cancer. A grant can be for anything from heating bills or extra clothing to a much-needed break.

Call us on 0808 808 00 00 to speak to a financial guide or benefits adviser, or to find out more about Macmillan Grants. We can also tell you about benefits advisers in your area.

Visit macmillan.org.uk/financialsupport to find out more about how we can help you with your finances.

Help with work and cancer

Whether you’re an employee, a carer, an employer or are self-employed, we can provide support and information to help you manage cancer at work. Visit macmillan.org.uk/work

Macmillan Organiser

This includes a records book to write down information such as appointments, medications and contact details. Visit be.macmillan.org.uk or call us on 0808 808 00 00. You can also download the app on IOS or Android.

Other useful organisations

There are lots of other organisations that can give you information or support.

Support for breathlessness

Breathlessness Intervention Service (BIS)

www.cuh.org.uk/breathlessness

A service that operates from the Cambridge University Hospitals website. Has videos and a range of fact sheets with information on managing breathlessness. Also has audio clips for relaxation.

British Lung Foundation

Helpline 0300 003 0555

(Mon to Fri, 9am to 5pm)

www.blf.org.uk

Supports people affected by any type of lung disease. Runs Breathe Easy support groups across the country.

Help Me Quit (Wales)

Tel 0808 250 6053

Text ‘HMQ’ to 80818

www.helpmequit.wales

Offers information, advice and support on stopping smoking in English and Welsh.

Mesothelioma UK

Helpline 0800 169 2409 (Mon to Fri, 8.30am to 4.30pm)

Email info@mesothelioma.uk.com

www.mesothelioma.uk.com

A national organisation providing up-to-date information for patients with mesothelioma and their carers through its helpline. Gives information on treatment, financial help, support services and support groups.

NHS Smokefree Helpline

Tel 0300 123 1044

(Mon to Fri, 9am to 8pm, and Sat to Sun, 11am to 4pm)

www.nhs.uk/smokefree

Offers information, advice and support to people who want to stop smoking or have already stopped and do not want to start again.

The Roy Castle Lung Foundation

Helpline 0333 323 7200

www.roycastle.org

Provides financial and emotional information and support to people with lung cancer. Also runs support groups and campaigns for lung cancer patients.

Stop Smoking NI (Northern Ireland)

www.stopsmokingni.info

Has information and advice about stopping smoking. Also links to other support organisations for people in Northern Ireland who want to give up smoking.

Quit

Quitline 0800 00 22 00

www.quit.org.uk

Offers practical help and advice to people who want to stop smoking.

Quit Your Way (Scotland)

Tel 0800 84 84 84 (Mon to Fri, 8am to 10pm and Sat to Sun, 9am to 5pm)

www.nhsinform.scot/care-support-and-rights/nhs-services/helplines/quit-your-way-scotland

Scotland’s national stop smoking support service. Offers advice and information about how to stop smoking. You can also chat online to an adviser.

General cancer support organisations

Cancer Black Care

Tel 0208 961 4151

www.cancerblackcare.org.uk

Offers UK-wide information and support for people from Black and ethnic minority communities who have cancer. Also supports their friends, carers and families.

Cancer Focus Northern Ireland

Helpline 0800 783 3339 (Mon to Fri, 9am to 1pm)

Email nurseline@cancerfocusni.org

www.cancerfocusni.org

Offers a variety of services to people affected by cancer in Northern Ireland.

Cancer Research UK

Helpline 0808 800 4040 (Mon to Fri, 9am to 5pm)

www.cancerresearchuk.org

A UK-wide organisation that has patient information on all types of cancer. Also has a clinical trials database.

Cancer Support Scotland

Tel 0800 652 4531 (Mon to Fri, 9am to 5pm)

Email info@cancersupportscotland.org

www.cancersupportscotland.org

Runs cancer support groups throughout Scotland. Also offers free complementary therapies and counselling to anyone affected by cancer.

Macmillan Cancer Voices

www.macmillan.org.uk/cancervoices

A UK-wide network that enables people who have or have had cancer, and those close to them such as family and carers, to speak out about their experience of cancer.

Maggie’s Centres

Tel 0300 123 1801

Email enquiries@maggiescentres.org

www.maggiescentres.org

Has a network of centres in many locations throughout the UK. Provides free information about cancer and financial benefits. Also offers emotional and social support to people with cancer, their family, and friends.

Penny Brohn UK

Helpline 0303 300 0118 (Mon to Fri, 9.30am to 5pm)

Email helpline@pennybrohn.org.uk

www.pennybrohn.org.uk

Offers physical, emotional and spiritual support across the UK, using complementary therapies and self-help techniques.

Tenovus

Helpline 0808 808 1010 (Daily, 8am to 8pm)

Email info@tenovuscancercare.org.uk

www.tenovuscancercare.org.uk

Aims to help everyone in the UK get equal access to cancer treatment and support. Funds research and provides support such as mobile cancer support units, a free helpline, benefits advice and an online ‘Ask the nurse’ service.

General health information

Health and Social Care in Northern Ireland

www.hscni.net

Provides information about health and social care services in Northern Ireland.

NHS.UK

www.nhs.uk

The UK’s biggest health information website. Has service information for England.

NHS Direct Wales

www.nhsdirect.wales.nhs.uk

NHS health information site for Wales.

NHS Inform

Helpline 0800 22 44 88 (Mon to Fri, 8am to 10pm, and Sat and Sun, 9am to 5pm)

www.nhsinform.scot

NHS health information site for Scotland.

Patient UK

www.patient.info

Provides people in the UK with information about health and disease. Includes evidence-based information leaflets on a wide variety of medical and health topics. Also reviews and links to many health- and illness-related websites.

Counselling

British Association for Counselling and Psychotherapy (BACP)

Tel 0145 588 3300

Email bacp@bacp.co.uk

Promotes awareness of counselling and signposts people to appropriate services across the UK. You can search for a qualified counsellor at itsgoodtotalk.org.uk

UK Council for Psychotherapy (UKCP)

Tel 0207 014 9955

Email info@ukcp.org.uk

www.psychotherapy.org.uk

Holds the national register of psychotherapists and psychotherapeutic counsellors, listing practitioners who meet exacting standards and training requirements.

Emotional and mental health support

Mind

Helpline 0300 123 3393 (Mon to Fri, 9am to 6pm)

Text 86463

Email info@mind.org.uk

www.mind.org.uk

Provides information, advice and support to anyone with a mental health problem through its helpline and website.

Samaritans

Helpline 116 123

Email jo@samaritans.org

www.samaritans.org

Provides confidential and non-judgemental emotional support, 24 hours a day, 365 days a year, for people experiencing feelings of distres or despair.

Financial or legal advice and information

Benefit Enquiry Line Northern Ireland

Helpline 0800 022 4250 (Mon, Tue, Wed and Fri, 9am to 5pm, and Thu, 10am to 5pm)

Textphone 0289 031 1092

www.nidirect.gov.uk/money-tax-and-benefits

Provides information and advice about disability benefits and carers’ benefits in Northern Ireland. You can also call the Make the Call helpline on 0800 232 1271 to check you are getting all the benefits you are eligible for.

Carer’s Allowance Unit

Tel 0800 731 0297

Textphone 0800 731 0317 (Mon to Fri, 8am to 6pm)

www.gov.uk/carers-allowance

Manages state benefits in England, Scotland and Wales. You can apply for benefits and find information online or through its helplines.

Citizens Advice

Provides advice on a variety of issues including financial, legal, housing and employment issues. Use their online webchat or find details for your local office in the phone book or by contacting:

England

Helpline 03444 111 444

www.citizensadvice.org.uk

Scotland

Helpline 0808 800 9060

www.cas.org.uk

Wales

Helpline 03444 77 2020

www.citizensadvice.org.uk/wales

Northern Ireland

Helpline 0800 028 1181

www.citizensadvice.co.uk

Money Advice Scotland

Tel 0141 572 0237

Email info@moneyadvicescotland.org.uk

www.moneyadvicescotland.org.uk

Use the website to find qualified financial advisers in Scotland.

NiDirect

www.nidirect.gov.uk

Has information about benefits and public services in Northern Ireland.

Unbiased.co.uk

Helpline 0800 023 6868

Email contact@unbiased.co.uk

www.unbiased.co.uk

You can search the website for qualified advisers in the UK who can give expert advice about finances, mortgages, accounting or legal issues.

Equipment and advice on living with a disability

British Red Cross

Tel 0344 871 1111

Textphone 0207 562 2050

Email information@redcross.org.uk

www.redcross.org.uk

Offers a range of health and social care services across the UK, such as care in the home, a medical equipment loan service and a transport service.

Disability Rights UK

Tel 0207 250 8181 (Mon to Fri, 10am to 12.30pm, then 1.30pm to 4pm)

Email enquiries@disabilityrightsuk.org

www.disabilityrightsuk.org

Provides information on social security benefits and disability rights in the UK. Has a number of helplines for specific support, including information on going back to work, direct payments, human rights issues, and advice for disabled students.

LGBT-specific support

LGBT Foundation

Tel 0345 330 3030 (Mon to Fri, 10am to 10pm, and Sat, 10am to 6pm)

Email helpline@lgbt.foundation

www.lgbt.foundation

Provides a range of services to the LGBT community, including a helpline, email advice and counselling. The website has information on various topics including sexual health, relationships, mental health, community groups and events.

Support for carers

Carers Trust

Tel 0300 772 9600 (Mon to Fri, 9am to 5pm)

Email info@carers.org

www.carers.org

Provides support, information, advice and services for people caring at home for a family member or friend. You can find details for UK offices and search for local support on the website.

Carers UK

Helpline (England, Scotland, Wales) 0808 808 7777

(Mon to Tue, 10am to 4pm)

Helpline (Northern Ireland) 028 9043 9843

www.carersuk.org

Offers information and support to carers across the UK. Has an online forum and can put people in contact with local support groups for carers.

Advanced cancer and end-of-life care

Hospice UK

Tel 0207 520 8200

Email info@hospiceuk.org

www.hospiceuk.org

Provides information about living with advanced illness. Also provides free booklets and a directory of hospice services in the UK.

Marie Curie

Helpline 0800 090 2309 (Mon to Fri, 8am to 6pm, and Sat, 11am to 5pm)

www.mariecurie.org.uk

Marie Curie nurses provide free end-of-life care across the UK. They care for people in their own homes or in Marie Curie hospices, 24 hours a day, 365 days a year.

Bereavement support

Cruse Bereavement Care

Helpline 0808 808 1677 (Mon, 9.30am to 5pm, Tue to Thu, 9.30am to 8pm, and Fri, 9.30am to 5pm)

Email info@cruse.org.uk

www.cruse.org.uk

Provides bereavement support to anyone who needs it across the UK. You can find your local branch on the website.

Disclaimer, thanks and sources

Disclaimer

We make every effort to ensure that the information we provide is accurate and up to date but it should not be relied upon as a substitute for specialist professional advice tailored to your situation. So far as is permitted by law, Macmillan does not accept liability in relation to the use of any information contained in this publication, or third-party information or websites included or referred to in it. Some photos are of models.

Thanks

This ebook has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been approved by Dr Sara Booth, Macmillan Consultant in Palliative Medicine.

With thanks to: Dr Emad Al-Rikabi, Specialty Doctor, Palliative Medicine; Jenny Cook, Lead Lung Cancer Specialist Nurse; Mark Teehan, Occupational Therapist; Dr Adrian Tookman, Consultant Physician Palliative Care; and Rachel Tuffnell, Physiotherapist, Breathlessness Intervention Service.

Thanks also to the people affected by cancer who reviewed this edition, and those who shared their stories.

We welcome feedback on our information. If you have any, please contact cancerinformationteam@macmillan.org.uk

Sources

We have listed a sample of the sources used in the ebook below. If you would like more information about the sources we use, please contact us at cancerinformationteam@macmillan.org.uk

Booth S, Chin C. Postgraduate medical journal. Managing breathlessness: a palliative approach. Vol 92, p393-400. 2016.

ESMO guidelines. Treatment of dyspnoea in advanced cancer patients. Clinical practice guidelines. 2015.

Can you do something to help?

We hope this ebook has been useful to you. It’s just one of our many publications that are available free to anyone affected by cancer. They’re produced by our cancer information specialists who, along with our nurses, benefits advisers, campaigners and volunteers, are part of the Macmillan team. When people are facing the toughest fight of their lives, we’re there to support them every step of the way.

We want to make sure no one has to go through cancer alone, so we need more people to help us. When the time is right for you, here are some ways in which you can become a part of our team.

Share your cancer experience

Support people living with cancer by telling your story, online, in the media or face to face.

Campaign for change

We need your help to make sure everyone gets the right support. Take an action, big or small, for better cancer care.

Help someone in your community

A lift to an appointment. Help with the shopping. Or just a cup of tea and a chat. Could you lend a hand?

Raise money

Whatever you like doing you can raise money to help. Take part in one of our events or create your own.

Give money

Big or small, every penny helps.

Call us to find out more 0300 1000 200

macmillan.org.uk/getinvolved